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Tobramycin injection (Nebcin)

Category:

  • Antibiotic

Description:

  • Aminoglycoside antibiotic

Indications:

  • Bacterial infections (P. aeruginosa, Proteus species (including P. mirabilis), M. morganii, E. coli, P. vulgaris, Klebsiella-Enterobacter-Serratia group, Citrobacter species, Staphylococcus species)

  • Septicemia (P. aeruginosa, E. coli, Klebsiella species)

  • Lower respiratory tract infections (P. aeruginosa, E. coli, Klebsiella species, Enterobacter species, Serratia species, S. aureus)

  • Serious bacterial infections of the CNS (meningitis)

  • Intra-abdominal infections, including peritonitis (, E. coli, Klebsiella species, Enterobacter species)

  • Skin, bone and soft tissue infections (P. aeruginosa, Proteus species, E. coli, Klebsiella species, Enterobacter species, S. aureus)

  • Complicated and recurrent urinary tract infections (P. aeruginosa, Proteus species, E. coli, Klebsiella species, Enterobacter species, Serratia species, Citrobacter species, Providencia species, S. aureus)

  • Cystic fibrosis nebulization therapy (P. aeruginosa)

Contraindications:

  • Generally not indicated for long-term therapy due to nephrotoxocity and ototoxicity

Precautions:

  • Pregnancy category D

  • May cause nephrotoxicity, therefore closely monitor renal function, especially in elderly patients.

  • May cause ototoxicity, therefore monitor hearing

  • Monitor peak and trough serum concentrations

  • In patients with extensive burns, altered pharmacokinetics may alter serum concentrations.

  • May produce hypomagnesemia, especially if poor or restricted diet.

  • Aminoglycosides have neuromuscular blockade activity with a curare-like effect.  Monitor patient’s neuromuscular function, especially in patients with myasthenia gravis, parkinsonism or infant botulism.

  • Cystic fibrosis patients may have altered pharmacokinetics, requiring reduced dosages

Adverse Reactions (Side Effects):

  • Central and peripheral nervous system reactions: Headache, delerium, confusion, lethargy

  • Gastrointestinal: vomiting, nausea, anorexia, hypersalivation

  • Hematologic: changes in reticulocyte counts, anemia, altered WBC counts

  • Hypersensitivity: rash, urticaria, itching

  • Special senses: dizziness, tinnitis, vertigo

  • Renal: clinduria, oliguria, proteinuria, increased creatinine and BUN

  • Miscellaneous: apnea, alopecia, joint pain

  • Pain at injection site

  • Decreased calcium, sodium, potassium and magnesium levels  

Dosage:

  • Administered by IM or IV injection or nebulization

  • Therapy duration is generally 7-10 days

  • Dosages based on patients ideal body weight

Adults: normal renal function: 3mg/kg/day IV or IM in 3 equal doses every 8 hours

Weight
 (pounds)
Weight
 (kg)
Q8 hour Dose (Moderate Infections)
132 60 60 mg IM/IV
154 70 70 mg IM/IV
176 80 80 mg IM/IV
198 90 90 mg IM/IV

Serious infections: 5mg/kg/day divided into 3-4 equal doses
Weight 
(pounds)
Weight 
(kg)
Q8 hour Dose (Serious Infections)
132 60 100 mg IM/IV
154 70 117 mg IM/IV
176 80 133 mg IM/IV
198 90 150 mg IM/IV
  • Children:

    • 6-7.5mg/kg/day in 3-4 equally divided doses

  • Premature or full term neonates (< 1 week of age):

    • <4mg/kg/day in 2 equally divided doses

  • Cystic fibrosis nebulization:

    • Adults and Children > 6 years: 300mg twice a day

    • given on a repeating cycle: 28 days on and 28 days off

 

 


The information contained here is an abbreviated summary. For more detailed and complete information, consult the manufacturer's product information sheets or standard textbooks

Source: Operational Medicine 2001,  Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300

This information is provided by The Brookside Associates.  The Brookside Associates, LLC. is a private organization, not affiliated with any governmental agency. The opinions presented here are those of the author and do not necessarily represent the opinions of the Brookside Associates or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. All material presented here is unclassified.

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